2017 Sec 1 Green Book

A.

Garin

et al.

/ International

Journal

of Pediatric Otorhinolaryngology 79

(2015)

1752–1760

Table 2 Neurological

symptoms,

CRP

levels,

size

of

empyema,

surgical

treatment

and

outcomes

in

patients with

SE.

Patient initials

Neurological symptoms a

Initial CRP

Bacteria

First procedure

Second procedure

Third procedure

Residual

symptoms

Extension of

level

empyema

treatments

during

and the

1st

last

visit

(mg/ml)

before

surgery b

(follow-up

duration)

ONA hole

ONA

(Burr

(frontal

and motor

BD

FND DC S MS

Speech

72

Extended

Gram positive

cocci

drainage)

and parietal craniotomy)

difficulties (27 months),

AEDs

DC

S MS

6

Localized

NG

EEA

ONA

(frontal

Intermittent headaches (22 months) Concentration problems, EEG abnormalities, AEDs

and parietal craniotomy)

(parietal

EEA

ONA

ID

S

NA

Extended

Streptococcus constellatus

and

craniotomy) and FSO

species

Prevotella

(23 months)

(Burr

hole

difficulties,

LM MS S

124

Localized

EEA FSDext

ONA

Schooling

Streptococcus

drainage + puncture

headaches (29 months)

of

BA

under

frontal

guidance)

US

intermedius

(parietal

ONA

(frontal

difficulties,

Schooling

PLam S

NA

Localized

EEA

ONA

Fusobacterium

and

and

parietal

craniotomy)

medial

frontal

defect,

AEDs

parietal craniotomies) + FSO

bone

necrophorum

(20 months)

RM FND A S

and

ONA

(Frontal

(24 months)

AEDs

NA

Extended

EEA

Streptococcus constellatus

and parietal craniotomy)

FSDext

PLen

MS

86

Extended

NG

EEA

Headaches (27 months) problem (18 months) No

(frontal

TL

S ICHS

292

Extended

ONA

Streptococcus species

medial craniotomy)

VJ

None

35

Extended

EEA ONA,

No problem (33 months)

Fusobacterium necrophorum

(frontal

and

medial

parietal craniotomies), FSO

requiring more

than one procedure. Unshaded portion: Cases

successfully

treated with a

single operation. AEDs: antiepileptic drugs BA: brain abscess

Shaded portion: Cases

focal neurological deficit FSD:

frontal sinus drainage, either

DC: decreased consciousness EEA: endoscopic ethmoidectomy and antrostomy EEG: electroencephalogram FND:

through

an

external

(FSDext)

or

through

an

endoscopic Draf

type

III

approach

(FSDendos)

FSO:

frontal

sinus

obliteration

ICHS:

Intracranial

hypertension

syndrome MS:

syndrome NA:

not

available NG:

no

bacterium

isolated

in

bacteriological

samples ONA:

open

neurosurgical

approach

S:

seizure.

Meningeal

a Headaches were

excluded

from

the

list

of

neurological

symptoms

as

it

could

have

also

resulted

from

sinusitis.

b Localized empyema corresponded

to empyema

located

in

the

front of

the polar or basal part of

the

frontal infected

lobe, next

to

the

infected

frontal and anterior ethmoid sinuses.

empyema

had

spread way

beyond

the

polar

or

basal

region

of

the

frontal

lobe

facing

the

sinus

(see

also

Figs.

1

and

4 ).

Extended

The

preoperative

CRP

levels

(mg/l)

(mean

SD)

were

not

cases

(17.5%)

(1

SE

and 2 EE).

There was no

clear

explanation

in

3

between

the

SE

(102

101)

and

EE

groups

(112

119).

the clinical charts concerning the choice of the

imaging

techniques.

different

did

the

CRP

levels

differ

between

patients

requiring

only

one

thickened

inflammatory mucosa,

possibly

associated with

Nor

A

127)

or

several

drainage

surgeries

(97

75).

the presence of pus, was observed in

the maxillary and ethmoidal

(114

Blood cultures were positive

in only one patient with SE and

in no

in

100%

of

cases,

in

the

frontal

sinus

in

88%

of

cases

sinuses

EE.

Perioperative

pus

samples were

positive

in

67%

( n = 15), and

in the sphenoid sinus

in 53% of cases ( n = 9). Fifty nine

patients with ( n = 6) of SE

(3 sinus samples and 3

intracranial samples) and

in 75%

cases of maxillary

and

ethmoidal

sinusitis,

and 59% of

percent of

( n = 6)

of

EE

(2

sinus

samples

and

4

intracranial

samples).

Lumbar

of

frontal

sinusitis were

bilateral.

Ethmoidal

inflammation

cases

in 4 patients with

SE due

to meningeal

concerned

the

interior

part

of

this

paranasal

sinus.

Two

punctures were performed

mostly

and

did

not

retrieve

any

bacteria.

In

cases

of

SE,

the

clearly

resulted

from

the

ethmoidal

sinus

since

these

syndrome

cases

bacteria

were

the

following:

did

not

have

any

frontal

sinus.

In

one

case,

the

EE

isolated

patients

Streptococcus

constellatus

( n = 2), Non-specified Streptococcus ( n = 2), Streptococcus intermedius ( n = 1), Fusobacteriumnecrophorum ( n = 1), Fusobacteriumnucleatum ( n = 1) and Provatella species ( n = 1). Bacteria isolated in children with EE were: S. intermedius ( n = 4), Staphylococcus lugdunensis ( n = 1) , Staphylococcus aureus ( n = 1), Staphylococcus capitis ( n = 1) and Propionobacterium acnes ( n = 1).

from a Pott’s puffy

tumor and not directly

from a

sinus

originated

cavity 1 , D1). In three cases (2SE and1 EE), the empyema and the infected sinus were not contiguous ( Fig. 2 ). An erosion of the posterior wall of the frontal sinus was observed in one case (EE) and an erosion of the ethmoidal roof in two cases (1 SE and 1 EE) ( Fig. 3 ). The locations and extensions of the empyema on the initial imaging and at the time of theirmaximal expansionare shown in Figs. 1 and4 , respectively. The locations of empyema were as follows: ( Fig.

Radiological

findings

3.3.

imaging

techniques

performed

before

the

first

surgical (6 SE and

The

the

following: CT scans

in 10 cases

(59%)

procedure were

For

SE,

the

frontal

polar

region

was

involved

in

89%

of

cases

in 4 cases

(23.5%)

(2 SE and 2 EE) and CT scan and MRI in

4 EE), MRI

( n = 8),

the

frontal basal

in one

case,

the parietal

region

in 78% of

85